Compelling commentary on children's health

Concerned about how to discuss your tummy tuck, nose job, or breast implants with your son? Apparently you’re not alone. A plastic surgeon in Florida thought it would be cute to publish a book on how to discuss cosmetic surgery with kids. This self-published gem, My Beautiful Mommy, apparently caught the attention of Newsweek who, by some act of God, actually featured it. All of the requisite concerned experts are quoted to make the whole thing actually seem legitimate. Somebody pinch me.

Perhaps I’m alone on this but as a professional charged with the welfare of children, I find the whole matter disturbing. While plastic and reconstructive surgery can do a great service, the suggestion that we openly discuss it with school-aged children is an abomination. To confront your own vanity is one thing. Confronting your vanity with a soul too young to recognize any part of it is quite another.

Here’s one pediatrician’s advice: Keep your implants to yourself. Should your children ever reach the point where they need guidance on issues of bodily enhancement, you can chime in. At that time your child will likely be better prepared to understand why and how of your decision.

Watch your back, Dr. Brown. The world is going green and clean. Canada recently banned BpA and from the looks of it, the American marketplace isn’t far behind. While American pediatricians haven't exactly addressed the issue, I feel the evidence is compelling enough to raise questions. And for my kids and my patients it’s BpA free. Even Playtex is doing the right thing by frankly discussing their products and pledging to convert on a going forward basis.

If you want to know more I strongly suggest that you spend some time with Safe Mama. The thorough nature of her content is only surpassed by her crisp writing. Just love those cheat sheets!

Scientists at the NIH recently studied the behavior of a gene that influences how much baby monkeys cry when away from their mothers. It seems that when baby monkeys hang around (literally) with their mothers they release opioids which make them feel good. When mom isn’t around, the opioids disappear and baby becomes unhappy. And it’s variations in the “mu-opioid gene” that determine just how hooked babies become. Researchers looked at 97 macaque monkeys and found that those with one particular mu-opioid variant are particularly sensitive to being away from mamma’s lovin’ arms.

Sound familiar? Those of us with more than one child know that no two babies are quite alike. And this is particularly true when it comes to fussy behavior. While I have always contended that acid reflux disease and milk protein allergy are wildly underestimated in babies, there’s a group of babies with neither of these conditions that cry for no apparent reason. This study gets us a little closer to understanding the neurologic differences that may explain what’s been observed for centuries.

Perhaps this is all inconsequential but who knows where it’ll lead. While I don’t think we’ll ever see the day when we consider gene therapy for the high need baby, it’s encouraging to learn that when babies cry, it’s often for reasons other than “poor maternal adjustment.”

My greatest fear as a father is that I won’t survive to see my children grow up. I guess I think that something terrible could happen to me before I see them get where they need to get. While it’s something I tend to keep to myself, it’s this fear that drew me to the story of Randy Pauch, a 47-year-old father of three with pancreatic cancer and only months to live. His book is The Last Lecture and it’s an adaption of his farewell lecture to students and colleagues at Carnegie Mellon University where he taught.

While I tend to shy away from tragic memoirs, I found myself drawn to the experience of someone at a similar station in life forced to confront his own demise. And the grace, vision and composure with which he handles his loss and the loss of his children is amazing. The Last Lecture could easily serve as a road map for any parent going through the same situation.

Time is the true currency. If you don’t think so you might want to listen to Randy Pauch. The Last Lecture is recommended reading for any parent who needs to be reminded about what’s really important.

If you have the chance, tune in to Dr. Mike over at Pediacast.He’s an Ohio-based pediatrician who serves up the latest in pediatric health in podcast format. Where else can you hear a live discussion on bowlegged babies, community beds, soft spots, and chocolate milk all in under 40 minutes? And he’ll take questions as well. The quality of the content as well as the sound is outstanding. The rumor is that he has a guest/interview format in the works. You can find him on iTunes.

I see it all the time: Health problems that require change. Change in diet, behavior or the way we live. And people are always willing to change themselves or their children, especially when their health is at risk. The problem is, we can’t keep it up. Cutting calories, increasing exercise, minimizing sugar intake, and other lofty goals can be reached over the short term. Long-term change is hard to maintain.

But small changes are doable and they can have a real impact. The consumption, for example, of just 10 extra calories per day – that’s one stick of gum – over a one year period will make you one pound heavier. And small, almost unnoticeable decreases in daily caloric intake can have similarly dramatic effects. When sustained, these almost invisible changes in behavior are more realistic than turning your life upside down.

My greatest success as a father and a pediatrician has been seen with small, reachable goals. While we all dream of big change, it's more likely to happen slowly than overnight.

Hold on to your vaulting horse. In a study published in this month’s Pediatrics, researchers at Ohio State University reviewed U.S. gymnastics injuries in girls between 1990 and 2001 and found that it carries one of the highest injury rates of all girls’ sports. Some 27,000 gymnasts sustain serious injuries every year – numbers similar to ice hockey, soccer and (full-contact) cheerleading. Gymnastics would appear to be something of an athletic wild, wild west with no standards or rules for spotters, coaches and gymnasts.

So what’s a parent to do? While it may be difficult to prove compliance, parents should seek out gyms where safety training specific to gymnastics is an enforced mandate of coaches and spotters. So what constitutes adequate and appropriate training? Your guess is as good as mine since these sorts of issues need internal policing. Remember, however, that it's pesky parents driven by provocative studies like this that force the industry to change itself.

Most interesting finding: Injuries tend to spike during Olympic years when every little girl decides she wants to be the next Mary Lou Retton.

AstraZeneca recently received FDA approval for the use of Nexium in children down to 12 months of age. We’re used to hearing about reflux in adults. What does this new approval mean for parents and kids?

Reflux is getting its due. While it’s hard to believe, there are holdouts who refuse to believe that reflux is an issue in children. Nexium’s approval is a boon for reflux awareness.

More options for treatment. While Prevacid has been approved for young children for some time, Nexium gives us another option. This is a good thing. As I suggest in my book Colic Solved, PPI medications are like shoes, no two 8 ½’s (my size) feel the same. While a child may do well with one, another may not work quite as well. It’s hard to explain why this is the case but its something pediatric refluxologists like myself notice.

Expect to see direct-to-parent advertising. In a saturated adult acid suppression market, look for pharma to pay attention to the final reflux frontier: children. I’m not being critical. For years pediatricians have been the redheaded stepchildren of the medical world, forced to take the runoff of adult mediations for pediatric use. This approval will have the often overlooked upside of raising parental awareness.

Expect to see overuse. Nexium’s approval in kids could have the often overlooked downside of abuse. While reflux is underestimated in the pediatric age group, the new new thing always has the potential for overuse. Educate yourself on acid reflux disease in children before committing your child to long-term use.

Look for price competition. Competition in the pediatric market means competitive pricing for parents and third party payers. And when Protonix finally makes it into childhood, this effect will only be amplified.

Don’t expect talk of the “Purple Pill.” It’s dispensed as a white powder packet that’s suspended in a small amount of water. “The Little White Packet” somehow doesn’t have the same cachet. And while I believe Nexium is a good acid suppressant, when it comes to kids the form of delivery is king. Nexium’s powder will have a hard time keeping up with Prevacid’s ever-popular strawberry-flavored melt away solutab. Kids love ‘em.

Approval for babies isn’t far behind. As the market for PPI’s continues to grow into the younger set, expect FDA approval of PPI for infants. I’d give it 2-3 years.

Stay tuned to Parenting Solved for more on Nexium’s effect on reflux awareness and the pediatric heartburn market.